Alec D. McCarthy, Kay Durairaj, Jacob Linneman-Heath, Dusan Sajic, Mara Dacso, Alan Durkin
Background
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained rapid popularity for both medical and consumer-directed weight loss. This growth has been accompanied by increased public discussion regarding facial aesthetic changes, commonly referred to as “Ozempic face,” characterized by volume depletion and cutaneous laxity.
Objective
To quantify temporal patterns of public search interest in a widely known GLP-1 RA and evaluate corresponding awareness of its cosmetic facial sequelae using infodemiologic methods.
Methods
Google Trends data for “Ozempic” and related frequently co-searched queries were analyzed from November 2021 to December 2024. Trends in relative search volume (RSV) were examined, with particular focus on terms associated with facial aesthetics, including “Ozempic face” and “plastic surgeons Ozempic face.”
Results
RSV for “Ozempic” showed a steady upward trajectory over the study period. Queries related to facial aesthetic consequences exhibited substantial proportional increases. Notably, “Ozempic face” demonstrated a 4600% rise in RSV, and searches for “plastic surgeons Ozempic face” similarly grew markedly.
Conclusions
Public interest in GLP-1 RAs is strongly associated with rising awareness and concern about their facial aesthetic effects. These trends suggest that aesthetic practitioners should expect more patient inquiries regarding GLP-1–related facial changes and should proactively integrate counseling and corrective treatment options into clinical practice.
{"title":"Rising Public Interest in Weight Loss Medications and Growing Awareness of Their Aesthetic Sequelae: An Infodemiologic Google Trends Analysis and Clinical Diagnostic Patterning","authors":"Alec D. McCarthy, Kay Durairaj, Jacob Linneman-Heath, Dusan Sajic, Mara Dacso, Alan Durkin","doi":"10.1111/jocd.70670","DOIUrl":"10.1111/jocd.70670","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained rapid popularity for both medical and consumer-directed weight loss. This growth has been accompanied by increased public discussion regarding facial aesthetic changes, commonly referred to as “Ozempic face,” characterized by volume depletion and cutaneous laxity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To quantify temporal patterns of public search interest in a widely known GLP-1 RA and evaluate corresponding awareness of its cosmetic facial sequelae using infodemiologic methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Google Trends data for “Ozempic” and related frequently co-searched queries were analyzed from November 2021 to December 2024. Trends in relative search volume (RSV) were examined, with particular focus on terms associated with facial aesthetics, including “Ozempic face” and “plastic surgeons Ozempic face.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>RSV for “Ozempic” showed a steady upward trajectory over the study period. Queries related to facial aesthetic consequences exhibited substantial proportional increases. Notably, “Ozempic face” demonstrated a 4600% rise in RSV, and searches for “plastic surgeons Ozempic face” similarly grew markedly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Public interest in GLP-1 RAs is strongly associated with rising awareness and concern about their facial aesthetic effects. These trends suggest that aesthetic practitioners should expect more patient inquiries regarding GLP-1–related facial changes and should proactively integrate counseling and corrective treatment options into clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Menopause is linked to typical skin changes such as textural alterations, loss of skin hydration, elasticity, thinning, and increased fragility. Dermal white adipose tissue (dWAT), a distinct fat component located in the dermis and involved in hair cycle regulation, antimicrobial peptide production, and extracellular matrix (ECM) modulation, decreases with aging and photodamage. Emerging evidence suggests that estrogen contributes to an inhibitory effect on dWAT and promotes fibrotic remodeling of adipose tissue of the dermis.
Objective
To examine the mechanistic evidence linking menopause with the loss of dWAT and to suggest and highlight potential strategies for replacing dWAT with agents such as magnolol, which promote the conversion of pre-adipocytes to adipocytes and restore lost fractions of the dWAT compartment.
Methods
A review of the literature, a mechanistic examination, a histologic examination, and a clinical trial assessment were conducted.
Results
The loss of dWAT and fibrotic replacement are likely a factor causally linked to the decrease in estrogen observed during menopause. Reduced dWAT produces fewer adipokines such as adiponectin, which is directly involved in skin health by promoting collagen and hyaluronic acid (HA) production. Evidence suggests that select non-hormonal agents can offer a potential therapeutic benefit to menopausal skin promoting dWAT restoration through adipogenic pathways.
Conclusion
dWAT depletion likely contributes to menopausal skin changes. Potential candidates for non-hormonal alternatives to address these menopausal concerns are discussed in this paper.
{"title":"Menopause and Dermal White Adipose Tissue Depletion: Mechanistic Links, Adipogenesis, and Regenerative Therapeutic Replacement","authors":"Alan D. Widgerow, Mary E. Ziegler, Faiza Shafiq","doi":"10.1111/jocd.70671","DOIUrl":"10.1111/jocd.70671","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Menopause is linked to typical skin changes such as textural alterations, loss of skin hydration, elasticity, thinning, and increased fragility. Dermal white adipose tissue (dWAT), a distinct fat component located in the dermis and involved in hair cycle regulation, antimicrobial peptide production, and extracellular matrix (ECM) modulation, decreases with aging and photodamage. Emerging evidence suggests that estrogen contributes to an inhibitory effect on dWAT and promotes fibrotic remodeling of adipose tissue of the dermis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the mechanistic evidence linking menopause with the loss of dWAT and to suggest and highlight potential strategies for replacing dWAT with agents such as magnolol, which promote the conversion of pre-adipocytes to adipocytes and restore lost fractions of the dWAT compartment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A review of the literature, a mechanistic examination, a histologic examination, and a clinical trial assessment were conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The loss of dWAT and fibrotic replacement are likely a factor causally linked to the decrease in estrogen observed during menopause. Reduced dWAT produces fewer adipokines such as adiponectin, which is directly involved in skin health by promoting collagen and hyaluronic acid (HA) production. Evidence suggests that select non-hormonal agents can offer a potential therapeutic benefit to menopausal skin promoting dWAT restoration through adipogenic pathways.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>dWAT depletion likely contributes to menopausal skin changes. Potential candidates for non-hormonal alternatives to address these menopausal concerns are discussed in this paper.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ablative fractional CO2 laser is effective for acne scar treatment but is often associated with side effects such as erythema and dyspigmentation, along with prolonged recovery time.
Aims
The study aimed to evaluate the post-procedure reparative effects of a combination of vitamin C, E, and ferulic acid (CE Ferulic) in Chinese patients with atrophic acne scars.
Methods
In this randomized, investigator-blinded, split-face, controlled trial, patients aged 18–50 with moderate-to-severe atrophic acne scars were randomly assigned to apply CE Ferulic to intervention-side face and normal saline (NS) to control-side face, immediately after ablative CO2 laser treatment for 14 days. Patients were further divided into once-daily and twice-daily application subgroups. During the 14-day follow-up, the wound healing (measured by scabbing stage on Day 7), erythema index (EI), melanin index (MI), skin hydration, and transepidermal water loss (TEWL) were evaluated. Direct assessment of scar improvement was not within the scope of this study.
Results
Sixty-four patients were included in the analysis. On Day 7, the intervention side showed a higher complete scab detachment rate than the control side (60.9% vs. 34.4%, p = 0.0026). EI and MI reduced significantly greater on the intervention side compared to the control side (Days 3, 7, and 14; p < 0.0001). On Day 14, the intervention side also demonstrated significantly better capability of maintaining skin hydration (p = 0.0367) and preventing TEWL (p = 0.0246) than the control side.
Conclusions
This study found that CE Ferulic led to enhanced wound healing, reduced erythema and melanin levels, and improved skin hydration following laser treatment, suggesting its beneficial application in combination with laser treatment to accelerate skin recovery.
Trial Registration
ChiCTR2300078214
背景：烧蚀分数CO2激光治疗痤疮疤痕是有效的，但通常伴有副作用，如红斑和色素沉着，以及恢复时间延长。目的：本研究旨在评估维生素C、E和阿魏酸（CE阿魏酸）联合治疗萎缩性痤疮疤痕的术后修复效果。方法：在这项随机、研究者盲法、裂面对照试验中，年龄18-50岁的中重度萎缩性痤疮疤痕患者在CO2激光消融治疗14天后，随机分配在干预侧面部应用CE阿魏酸，在对照组面部应用生理盐水（NS）。患者进一步分为每日一次和每日两次应用亚组。随访14 d，评估创面愈合（第7天结痂分期）、红斑指数（EI）、黑色素指数（MI）、皮肤水化、经皮失水（TEWL）。直接评估疤痕改善不在本研究范围内。结果：64例患者纳入分析。第7天，干预组的结痂完全脱离率高于对照组（60.9% vs. 34.4%, p = 0.0026）。与对照组相比，干预组的EI和MI显著降低（第3、7和14天）；p结论：本研究发现，CE阿魏酸可促进伤口愈合，减少红斑和黑色素水平，改善激光治疗后皮肤水合作用，提示其与激光治疗联合使用可加速皮肤恢复。试验注册：ChiCTR2300078214。
{"title":"Reparative Effects of a Topical Antioxidant Serum Containing Vitamin C, Vitamin E, and Ferulic Acid After Ablative Fractional CO2 Laser Treatment for Atrophic Acne Scars: A Randomized, Investigator-Blinded, Split-Face, Controlled Trial","authors":"Yu Shi, Sijia Xu, Wei Zhang","doi":"10.1111/jocd.70634","DOIUrl":"10.1111/jocd.70634","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ablative fractional CO<sub>2</sub> laser is effective for acne scar treatment but is often associated with side effects such as erythema and dyspigmentation, along with prolonged recovery time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The study aimed to evaluate the post-procedure reparative effects of a combination of vitamin C, E, and ferulic acid (CE Ferulic) in Chinese patients with atrophic acne scars.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this randomized, investigator-blinded, split-face, controlled trial, patients aged 18–50 with moderate-to-severe atrophic acne scars were randomly assigned to apply CE Ferulic to intervention-side face and normal saline (NS) to control-side face, immediately after ablative CO<sub>2</sub> laser treatment for 14 days. Patients were further divided into once-daily and twice-daily application subgroups. During the 14-day follow-up, the wound healing (measured by scabbing stage on Day 7), erythema index (EI), melanin index (MI), skin hydration, and transepidermal water loss (TEWL) were evaluated. Direct assessment of scar improvement was not within the scope of this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-four patients were included in the analysis. On Day 7, the intervention side showed a higher complete scab detachment rate than the control side (60.9% vs. 34.4%, <i>p</i> = 0.0026). EI and MI reduced significantly greater on the intervention side compared to the control side (Days 3, 7, and 14; <i>p</i> < 0.0001). On Day 14, the intervention side also demonstrated significantly better capability of maintaining skin hydration (<i>p</i> = 0.0367) and preventing TEWL (<i>p</i> = 0.0246) than the control side.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study found that CE Ferulic led to enhanced wound healing, reduced erythema and melanin levels, and improved skin hydration following laser treatment, suggesting its beneficial application in combination with laser treatment to accelerate skin recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ChiCTR2300078214</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Skin boosters are commonly administered into the dermis or immediate subdermal plane using serial puncture technique. Alternative delivery methods, such as blunt cannulas and multiple-needle injector devices, are available, but their ability to achieve comparable clinical outcomes has been under-investigated. This case series presents the first prospective comparative evaluation of CPM-HA20G administered via three different modalities, assessing efficacy, safety, and adverse events, while utilizing ultrasound to confirm product placement. To minimize patient-related variability, a split-face study design was also employed.
Objective
To demonstrate the efficacy, safety, and comparability of results when delivering CPM-HA20G via multiple modalities into the immediate subdermal plane.
Methods
Fifteen patients received three treatments of CPM-HA20G, four weeks apart, using serial puncture, blunt cannula, and multiple-needle injector device. A separate split-face case compared serial puncture with blunt cannula delivery in the same patient, with ultrasound confirmation of product placement. Satisfaction rates, pain scores, and skin quality were assessed at 4, 8, and 12 weeks.
Results
All 15 patients across the three modalities achieved comparable improvements in skin elasticity, firmness, and hydration. High patient satisfaction was reported, with no serious adverse effects observed. A paired t-test showed pain scores were significantly lower with blunt cannula (mean 2.2) compared with serial puncture (mean 4.6) and injector device (mean 4.5) (p < 0.0001). Blunt cannula delivery was also associated with a lower incidence of bruising, suggesting clinical advantages for patient comfort and recovery.
Conclusion
This case series demonstrates that serial puncture technique, blunt cannula and multiple-needle injector device can be used to deliver safe, comparable, and effective CPM-HA20G treatments. These findings highlight comparable efficacy across modalities and suggest blunt-cannula delivery enhances patient comfort and recovery time.
{"title":"Facial Skin Revitalization With CPM-HA20G (Hyaluronic Acid + Glycerol): A Comparative Case Series Using Three Delivery Techniques With Ultrasound Confirmation","authors":"Kim Booysen, Frank Lin","doi":"10.1111/jocd.70660","DOIUrl":"10.1111/jocd.70660","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Skin boosters are commonly administered into the dermis or immediate subdermal plane using serial puncture technique. Alternative delivery methods, such as blunt cannulas and multiple-needle injector devices, are available, but their ability to achieve comparable clinical outcomes has been under-investigated. This case series presents the first prospective comparative evaluation of CPM-HA20G administered via three different modalities, assessing efficacy, safety, and adverse events, while utilizing ultrasound to confirm product placement. To minimize patient-related variability, a split-face study design was also employed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To demonstrate the efficacy, safety, and comparability of results when delivering CPM-HA20G via multiple modalities into the immediate subdermal plane.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifteen patients received three treatments of CPM-HA20G, four weeks apart, using serial puncture, blunt cannula, and multiple-needle injector device. A separate split-face case compared serial puncture with blunt cannula delivery in the same patient, with ultrasound confirmation of product placement. Satisfaction rates, pain scores, and skin quality were assessed at 4, 8, and 12 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All 15 patients across the three modalities achieved comparable improvements in skin elasticity, firmness, and hydration. High patient satisfaction was reported, with no serious adverse effects observed. A paired <i>t</i>-test showed pain scores were significantly lower with blunt cannula (mean 2.2) compared with serial puncture (mean 4.6) and injector device (mean 4.5) (<b><i>p</i> < 0.0001</b>). Blunt cannula delivery was also associated with a lower incidence of bruising, suggesting clinical advantages for patient comfort and recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case series demonstrates that serial puncture technique, blunt cannula and multiple-needle injector device can be used to deliver safe, comparable, and effective CPM-HA20G treatments. These findings highlight comparable efficacy across modalities and suggest blunt-cannula delivery enhances patient comfort and recovery time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kyu-Ho Yi, Isaac Kai Jie Wong, Irwan Junawanto, Gi-Woong Hong, Han Earl Lee, Jovian Wan
Background
The platysma muscle plays a pivotal role in the formation of vertical neck bands and contributes to lower facial descent, making it a prime target for botulinum toxin type A (BoNT-A) in aesthetic neck rejuvenation. Conventional protocols typically involve injecting across the entire muscle, necessitating a high number of injection points and larger total doses, which may increase the risk of bruising, patient discomfort, and potential immunogenicity. Recent anatomical studies using Sihler's staining have demonstrated that motor innervation is predominantly concentrated in the upper portion of the platysma.
Aims
To evaluate a neural distribution–based BoNT-A injection strategy targeting only the motor-rich upper platysma, compared with the conventional whole-muscle injection approach.
Methods
Fifteen patients with prominent platysmal bands received BoNT-A injections (JETEMA THE TOXIN, JETEMA Inc., Korea) in a split-side design: The right platysma was injected using a conventional 30-point technique, and the left platysma received 15 targeted injections in the upper portion based on mapped motor entry points. Efficacy was assessed by the degree of platysmal band relaxation at follow-up.
Results
Both techniques achieved comparable improvement in platysmal band appearance, despite the targeted side requiring 50% fewer injection points.
Conclusions
Motor innervation–guided BoNT-A injections may achieve equivalent clinical outcomes while reducing injection burden, toxin dose, and complication risk.
背景：颈宽肌在垂直颈带的形成中起着关键作用，有助于面部下降，使其成为a型肉毒杆菌毒素（BoNT-A）在颈部美容年轻化中的主要目标。传统的方案通常涉及整个肌肉注射，需要大量的注射点和更大的总剂量，这可能增加挫伤、患者不适和潜在的免疫原性的风险。最近的解剖研究表明，运动神经支配主要集中在颈阔肌的上部。目的：与传统的全肌注射方法相比，评估一种基于神经分布的BoNT-A注射策略，该策略仅针对运动丰富的上阔阔肌。方法：15例突出的颈颈带患者接受BoNT-A注射（JETEMA THE TOXIN, JETEMA Inc., Korea），采用裂侧设计：使用传统的30点技术注射右颈颈肌，根据映射的运动入口点在左颈颈肌上半部分接受15次靶向注射。随访时以颈侧肌束松弛程度评价疗效。结果：两种技术均取得了相当程度的改善，尽管目标侧需要的注射点减少了50%。结论：运动神经引导下的BoNT-A注射可以达到相同的临床效果，同时减少注射负担、毒素剂量和并发症风险。
{"title":"Neural Distribution–Guided Botulinum Toxin Injection for Platysma muscle: A Split-Neck Comparison With Conventional Technique","authors":"Kyu-Ho Yi, Isaac Kai Jie Wong, Irwan Junawanto, Gi-Woong Hong, Han Earl Lee, Jovian Wan","doi":"10.1111/jocd.70645","DOIUrl":"10.1111/jocd.70645","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The platysma muscle plays a pivotal role in the formation of vertical neck bands and contributes to lower facial descent, making it a prime target for botulinum toxin type A (BoNT-A) in aesthetic neck rejuvenation. Conventional protocols typically involve injecting across the entire muscle, necessitating a high number of injection points and larger total doses, which may increase the risk of bruising, patient discomfort, and potential immunogenicity. Recent anatomical studies using Sihler's staining have demonstrated that motor innervation is predominantly concentrated in the upper portion of the platysma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate a neural distribution–based BoNT-A injection strategy targeting only the motor-rich upper platysma, compared with the conventional whole-muscle injection approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifteen patients with prominent platysmal bands received BoNT-A injections (JETEMA THE TOXIN, JETEMA Inc., Korea) in a split-side design: The right platysma was injected using a conventional 30-point technique, and the left platysma received 15 targeted injections in the upper portion based on mapped motor entry points. Efficacy was assessed by the degree of platysmal band relaxation at follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both techniques achieved comparable improvement in platysmal band appearance, despite the targeted side requiring 50% fewer injection points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Motor innervation–guided BoNT-A injections may achieve equivalent clinical outcomes while reducing injection burden, toxin dose, and complication risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12789713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fine lines under the lower eyelid are among the earliest and most prominent signs of facial aging. However, despite growing interest in noninvasive aesthetic procedures targeting this area, there is currently no validated clinical scale specifically designed to assess the severity of infraorbital fine lines. Furthermore, existing assessment tools—such as those for lateral canthal lines or infraorbital hollowing—fail to adequately capture the unique characteristics of horizontally oriented fine wrinkles in this region.
Aims
To develop and validate a novel photonumeric clinical grading tool, called the PharmaResearch Under Eyelid Fine Line Severity (PULS) scale, for the standardized assessment of infraorbital fine lines.
Methods
A total of 53 healthy adults without facial dermatologic conditions were photographed under standardized conditions. From the resulting image set, 73 photographs (53 unique and 20 duplicate images) were selected. Five board-certified dermatologists used our newly developed 5-grade photonumeric scale to independently evaluate the severity of infraorbital fine lines. Inter- and intra-rater reliability was assessed using Fleiss' and Cohen's Kappa, respectively. Agreement rates were also calculated.
Results
Inter-rater reliability analysis yielded a Fleiss' Kappa of 0.6114, indicating good inter-rater agreement. All raters showed perfect intra-rater reliability, with Cohen's Kappa values of 1.0000. The overall agreement rate across all evaluations exceeded 80%, supporting the reproducibility and consistency of the PULS scale.
Conclusions
The PULS scale is a validated, reliable, and practical photonumeric grading tool that can address an unmet need in aesthetic dermatology by facilitating standardized evaluation of treatment outcomes for infraorbital fine lines in both clinical research and routine practice.
{"title":"The PharmaResearch Under Eyelid Fine Line Severity Scale: Development and Validation of a Standardized Clinical Assessment Tool for Infraorbital Fine Wrinkles","authors":"Sun Young Choi, Beom Joon Kim","doi":"10.1111/jocd.70583","DOIUrl":"10.1111/jocd.70583","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fine lines under the lower eyelid are among the earliest and most prominent signs of facial aging. However, despite growing interest in noninvasive aesthetic procedures targeting this area, there is currently no validated clinical scale specifically designed to assess the severity of infraorbital fine lines. Furthermore, existing assessment tools—such as those for lateral canthal lines or infraorbital hollowing—fail to adequately capture the unique characteristics of horizontally oriented fine wrinkles in this region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To develop and validate a novel photonumeric clinical grading tool, called the PharmaResearch Under Eyelid Fine Line Severity (PULS) scale, for the standardized assessment of infraorbital fine lines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 53 healthy adults without facial dermatologic conditions were photographed under standardized conditions. From the resulting image set, 73 photographs (53 unique and 20 duplicate images) were selected. Five board-certified dermatologists used our newly developed 5-grade photonumeric scale to independently evaluate the severity of infraorbital fine lines. Inter- and intra-rater reliability was assessed using Fleiss' and Cohen's Kappa, respectively. Agreement rates were also calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Inter-rater reliability analysis yielded a Fleiss' Kappa of 0.6114, indicating good inter-rater agreement. All raters showed perfect intra-rater reliability, with Cohen's Kappa values of 1.0000. The overall agreement rate across all evaluations exceeded 80%, supporting the reproducibility and consistency of the PULS scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The PULS scale is a validated, reliable, and practical photonumeric grading tool that can address an unmet need in aesthetic dermatology by facilitating standardized evaluation of treatment outcomes for infraorbital fine lines in both clinical research and routine practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12783871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aditya K. Gupta, Mary A. Bamimore, Tong Wang, Vincent Piguet, Mesbah Talukder
Background
Recently, the literature has expanded with peer-reviewed studies on immunomodulatory agents' efficacy on scalp psoriasis—which, in turn, widened knowledge gaps regarding these agents' relative effectiveness. We determined the relative efficacy of immunomodulatory monotherapies for scalp psoriasis.
Methods
We ran Bayesian network meta-analyses (NMAs) using outcomes related to Psoriasis Scalp Severity Index (PSSI) and scalp-specific Physician's Global Assessment of clear (0) or almost clear (1) (Sc-PGA 0/1).
Results
We estimated the relative efficacy of 22 interventions (including placebo), and analyzed 9 outcomes, namely: proportion of participants who attained Sc-PGA 0/1, proportion of participants who achieved 100% improvement in PSSI (PSSI-100), and proportion of participants who achieved 90% improvement in PSSI (PSSI-90) at 8, 12, and 16 weeks.
Conclusions
We are the first to provide comparative evidence on the efficacy of newly investigated agents such as deucravacitinib, tildrakizumab, roflumilast and icotrokinra. In general, the IL-17 inhibitors (bimekizumab, ixekizumab, secukinumab, brodalumab) and IL-23 inhibitors (icotrokinra, guselkumab, tildrakizumab) were effective depending upon the outcome and time-point being considered. At 16 weeks, for PSSI-100, ixekizumab 150 mg at weeks 0, 2, 4, 8, and 12 ranked highest; at 16 weeks, for Sc-PGA 0/1 bimekizumab 320 mg every 4 weeks ranked highest; at 8 weeks, for PSSI-100 ixekizumab 80 mg every 2 weeks ranked highest; at 8 weeks, for Sc-PGA 0/1 secukinumab 300 mg at weeks 1, 2, 3 and then every 4 weeks ranked highest. Small-molecule therapies (apremilast, deucravacitinib, roflumilast) improved scalp psoriasis modestly. Our work would guide the design of future studies and clinical decision-making.
{"title":"Relative Efficacy of Immunomodulatory Monotherapies for Psoriasis of the Scalp: A Network Meta-Analysis Study","authors":"Aditya K. Gupta, Mary A. Bamimore, Tong Wang, Vincent Piguet, Mesbah Talukder","doi":"10.1111/jocd.70662","DOIUrl":"10.1111/jocd.70662","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recently, the literature has expanded with peer-reviewed studies on immunomodulatory agents' efficacy on scalp psoriasis—which, in turn, widened knowledge gaps regarding these agents' relative effectiveness. We determined the relative efficacy of immunomodulatory monotherapies for scalp psoriasis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We ran Bayesian network meta-analyses (NMAs) using outcomes related to Psoriasis Scalp Severity Index (PSSI) and scalp-specific Physician's Global Assessment of clear (0) or almost clear (1) (Sc-PGA 0/1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We estimated the relative efficacy of 22 interventions (including placebo), and analyzed 9 outcomes, namely: proportion of participants who attained Sc-PGA 0/1, proportion of participants who achieved 100% improvement in PSSI (PSSI-100), and proportion of participants who achieved 90% improvement in PSSI (PSSI-90) at 8, 12, and 16 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We are the first to provide comparative evidence on the efficacy of newly investigated agents such as deucravacitinib, tildrakizumab, roflumilast and icotrokinra. In general, the IL-17 inhibitors (bimekizumab, ixekizumab, secukinumab, brodalumab) and IL-23 inhibitors (icotrokinra, guselkumab, tildrakizumab) were effective depending upon the outcome and time-point being considered. At 16 weeks, for PSSI-100, ixekizumab 150 mg at weeks 0, 2, 4, 8, and 12 ranked highest; at 16 weeks, for Sc-PGA 0/1 bimekizumab 320 mg every 4 weeks ranked highest; at 8 weeks, for PSSI-100 ixekizumab 80 mg every 2 weeks ranked highest; at 8 weeks, for Sc-PGA 0/1 secukinumab 300 mg at weeks 1, 2, 3 and then every 4 weeks ranked highest. Small-molecule therapies (apremilast, deucravacitinib, roflumilast) improved scalp psoriasis modestly. Our work would guide the design of future studies and clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ting Liao, Rui Luo, Ying Deng, Hongqiu Yang, Yu Du
Background
Melasma is a chronic, relapsing hyperpigmentation disorder driven by complex interactions among genetic predisposition, hormonal fluctuations, UV exposure, oxidative stress, inflammation, and photoaging. Its psychosocial impact is substantial, especially among women with darker skin types, and treatment remains challenging due to its multifactorial pathogenesis and high recurrence rates.
Aims
This review aims to synthesize current knowledge on melasma pathophysiology, highlight recent innovations in topical and procedural therapies, identify limitations of existing treatments, and outline future directions toward personalized and regenerative approaches.
Patients/Methods
A narrative literature review was performed, summarizing findings from epidemiologic studies, molecular investigations, and clinical trials. Key topics included pigment biology, hormonal and environmental triggers, oxidative stress pathways, emerging depigmenting agents, laser and microneedling technologies, combination therapies, and advances in precision medicine.
Results
Melasma arises from dysregulated melanogenesis involving hyperactive melanocytes, hormonal stimulation, UV-induced oxidative stress, dermal inflammation, fibroblast senescence, and pigmentary incontinence. Innovations include non-hydroquinone brighteners (e.g., thiamidol, melasyl), antioxidants, tranexamic acid, and improved topical delivery systems. Procedural advances—such as low-fluence picosecond lasers, fractional CO2 laser–assisted drug delivery, chemical peel hybrids, and exosome-augmented microneedling—offer enhanced pigment clearance with improved safety profiles. Nevertheless, treatment durability remains limited by relapse, heterogeneous disease subtypes, PIH risk, and inconsistent adherence.
Conclusions
Melasma management is evolving toward multi-target, combination-based strategies addressing pigmentation, inflammation, and photoaging simultaneously. Emerging regenerative technologies, biomarker-driven personalization, and AI-assisted assessment hold promise for improving long-term outcomes, though standardized protocols and long-term safety data are still needed.
{"title":"Targeting Melasma: Innovations in Pigment Deposition and Photoaging in Cosmetic Dermatology","authors":"Ting Liao, Rui Luo, Ying Deng, Hongqiu Yang, Yu Du","doi":"10.1111/jocd.70665","DOIUrl":"10.1111/jocd.70665","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Melasma is a chronic, relapsing hyperpigmentation disorder driven by complex interactions among genetic predisposition, hormonal fluctuations, UV exposure, oxidative stress, inflammation, and photoaging. Its psychosocial impact is substantial, especially among women with darker skin types, and treatment remains challenging due to its multifactorial pathogenesis and high recurrence rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This review aims to synthesize current knowledge on melasma pathophysiology, highlight recent innovations in topical and procedural therapies, identify limitations of existing treatments, and outline future directions toward personalized and regenerative approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients/Methods</h3>\u0000 \u0000 <p>A narrative literature review was performed, summarizing findings from epidemiologic studies, molecular investigations, and clinical trials. Key topics included pigment biology, hormonal and environmental triggers, oxidative stress pathways, emerging depigmenting agents, laser and microneedling technologies, combination therapies, and advances in precision medicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Melasma arises from dysregulated melanogenesis involving hyperactive melanocytes, hormonal stimulation, UV-induced oxidative stress, dermal inflammation, fibroblast senescence, and pigmentary incontinence. Innovations include non-hydroquinone brighteners (e.g., thiamidol, melasyl), antioxidants, tranexamic acid, and improved topical delivery systems. Procedural advances—such as low-fluence picosecond lasers, fractional CO<sub>2</sub> laser–assisted drug delivery, chemical peel hybrids, and exosome-augmented microneedling—offer enhanced pigment clearance with improved safety profiles. Nevertheless, treatment durability remains limited by relapse, heterogeneous disease subtypes, PIH risk, and inconsistent adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Melasma management is evolving toward multi-target, combination-based strategies addressing pigmentation, inflammation, and photoaging simultaneously. Emerging regenerative technologies, biomarker-driven personalization, and AI-assisted assessment hold promise for improving long-term outcomes, though standardized protocols and long-term safety data are still needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12783984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background</h3> <p>Botulinum toxin type A (BoNT-A) is widely recognized as the leading nonsurgical cosmetic treatment worldwide for diminishing dynamic wrinkles in the glabellar, forehead, and periorbital areas. While BoNT-A is widely acknowledged for its effectiveness and popularity, there are notable inconsistencies in results, methodologies, and safety reporting across clinical studies, highlighting the necessity for the careful development of strong, evidence-driven guidelines.</p> </section> <section> <h3> Objectives</h3> <p>This study aimed to compile and evaluate data from clinical research focusing on upper-face BoNT-A injections, specifically regarding safety outcomes, effectiveness, patient satisfaction, and response rates. This investigation concentrated on the outcomes of the clinical trials conducted.</p> </section> <section> <h3> Methods</h3> <p>This analysis includes prospective cohorts, randomized controlled trials, and observational studies that report on BoNT-A cosmetic treatments specifically in the upper face area. A thorough examination of MEDLINE, EMBASE, Cochrane Library, and Web of Science studies was conducted, covering literature up to May 2025. The assessment included response rates, levels of patient satisfaction, and the extent of wrinkle reduction. The analysis employed a random-effects model to produce combined estimates, followed by an assessment of heterogeneity utilizing <i>τ</i><sup>2</sup>, <i>I</i><sup>2</sup>, and Cochran's <i>Q</i>. Forest diagrams and Egger's test were utilized to evaluate publication bias and the effects of small studies when applicable.</p> </section> <section> <h3> Results</h3> <p>After the administration of BoNT-A therapy, a notable decrease in the severity ratings of wrinkles was observed, as indicated by the synthesis of ten clinical trials examining this aspect (Cohen's <i>d</i> = 1.93; 95% CI: 1.60–2.25; <i>p</i> = 0.001). However, the data also revealed a considerable degree of variability (<i>I</i><sup>2</sup> = 90%). The findings indicated substantial variability in effect sizes related to patient satisfaction across four distinct trials (Cohen's <i>d</i> = 22.54; 95% CI: −2.07–47.15; <i>p</i> = 0.07), accompanied by significant heterogeneity (<i>I</i><sup>2</sup> = 99.9%) and potential indications of publication bias. The findings revealed significant variability (<i>I</i><sup>2</sup> = 100%) and wide prediction intervals, indicating substantial inconsistency and limited applicability of the response outcomes in future research. Analysis of five studies regard
背景：A型肉毒毒素（BoNT-A）被广泛认为是世界范围内减少眉间、前额和眶周区域动态皱纹的主要非手术美容治疗方法。虽然BoNT-A因其有效性和受欢迎程度而得到广泛认可，但在临床研究的结果、方法和安全性报告方面存在明显的不一致，这突出了仔细制定强有力的、循证驱动的指南的必要性。目的：本研究旨在收集和评估上面部BoNT-A注射的临床研究数据，特别是关于安全性、有效性、患者满意度和反应率。这项调查集中于临床试验的结果。方法：本分析包括前瞻性队列、随机对照试验和观察性研究，这些研究报告了BoNT-A美容治疗，特别是在上面部区域。对MEDLINE、EMBASE、Cochrane Library和Web of Science研究进行了彻底的检查，涵盖了截至2025年5月的文献。评估包括反应率、患者满意度水平和皱纹减少程度。分析采用随机效应模型进行综合估计，然后利用τ2、I2和Cochran’s q对异质性进行评估。在适用的情况下，使用Forest图和Egger检验来评估发表偏倚和小型研究的影响。结果：在给予BoNT-A治疗后，观察到皱纹严重程度评分显着降低，这是由10项临床试验综合检查这方面的结果（Cohen's d = 1.93; 95% CI: 1.60-2.25; p = 0.001）。然而，数据也显示了相当程度的可变性（I2 = 90%）。研究结果表明，在四个不同的试验中，与患者满意度相关的效应大小存在显著差异（Cohen’s d = 22.54; 95% CI: -2.07-47.15; p = 0.07），并伴有显著的异质性（I2 = 99.9%）和潜在的发表偏倚迹象。研究结果显示了显著的可变性（I2 = 100%）和较宽的预测区间，表明响应结果在未来研究中存在很大的不一致性和有限的适用性。对五项关于反应率的研究的分析显示了显著的总体效果（Cohen’s d = 34.30; 95% CI: 3.65-64.94; p = 0.28）。总体影响被认为是值得注意的。结论：BoNT-A注射有助于减少皱纹严重程度，改善上面部的临床效果。研究表明，在患者满意度和反应率方面，存在显著的可变性和偏倚易感性。研究结果强调了亚组分析、强化报告方法和统一结果评估的必要性，以确定导致BoNT-A治疗反应差异的因素。试验注册：本研究按照PROSPERO指南进行。
{"title":"Cosmetic Botulinum Toxin A Injections to the Upper Face: A Systematic Review and Meta-Analysis of Clinical Studies","authors":"Alaa Safia, Uday Abd Elhadi, Shlomo Merchavy, Ramzy Batheesh, Naji Bathish","doi":"10.1111/jocd.70655","DOIUrl":"10.1111/jocd.70655","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Botulinum toxin type A (BoNT-A) is widely recognized as the leading nonsurgical cosmetic treatment worldwide for diminishing dynamic wrinkles in the glabellar, forehead, and periorbital areas. While BoNT-A is widely acknowledged for its effectiveness and popularity, there are notable inconsistencies in results, methodologies, and safety reporting across clinical studies, highlighting the necessity for the careful development of strong, evidence-driven guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to compile and evaluate data from clinical research focusing on upper-face BoNT-A injections, specifically regarding safety outcomes, effectiveness, patient satisfaction, and response rates. This investigation concentrated on the outcomes of the clinical trials conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This analysis includes prospective cohorts, randomized controlled trials, and observational studies that report on BoNT-A cosmetic treatments specifically in the upper face area. A thorough examination of MEDLINE, EMBASE, Cochrane Library, and Web of Science studies was conducted, covering literature up to May 2025. The assessment included response rates, levels of patient satisfaction, and the extent of wrinkle reduction. The analysis employed a random-effects model to produce combined estimates, followed by an assessment of heterogeneity utilizing <i>τ</i><sup>2</sup>, <i>I</i><sup>2</sup>, and Cochran's <i>Q</i>. Forest diagrams and Egger's test were utilized to evaluate publication bias and the effects of small studies when applicable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After the administration of BoNT-A therapy, a notable decrease in the severity ratings of wrinkles was observed, as indicated by the synthesis of ten clinical trials examining this aspect (Cohen's <i>d</i> = 1.93; 95% CI: 1.60–2.25; <i>p</i> = 0.001). However, the data also revealed a considerable degree of variability (<i>I</i><sup>2</sup> = 90%). The findings indicated substantial variability in effect sizes related to patient satisfaction across four distinct trials (Cohen's <i>d</i> = 22.54; 95% CI: −2.07–47.15; <i>p</i> = 0.07), accompanied by significant heterogeneity (<i>I</i><sup>2</sup> = 99.9%) and potential indications of publication bias. The findings revealed significant variability (<i>I</i><sup>2</sup> = 100%) and wide prediction intervals, indicating substantial inconsistency and limited applicability of the response outcomes in future research. Analysis of five studies regard","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12783872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rahul Balach, Ayan Khalid, Anas Rasool, Aamna Kashif, Abdullah Ahmad, Aroosa Zafar, Muhammad Ibrahim, Aamir Shahid Javed, Misha Hasan, Somaiya Ahmed
Background
Cutaneous warts are common benign lesions caused by human papillomavirus and often resist conventional treatments. Intralesional immunotherapy with measles–mumps–rubella (MMR) vaccine or vitamin D3 has emerged as an alternative, but their comparative efficacy and safety remain unclear.
Methods
We conducted a systematic review and meta-analysis of nine randomized controlled trials (RCTs) including 742 patients comparing intralesional MMR with vitamin D3 for nongenital cutaneous warts. We searched PubMed, Cochrane CENTRAL, and ScienceDirect up to June 2025, and the protocol was registered in PROSPERO (ID: 1128443). Primary outcomes were complete, partial, and no response; secondary outcomes were recurrence and adverse events (erythema, pain, swelling). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.
Results
Vitamin D3 achieved lower complete clearance than MMR (RR 0.85; 95% CI 0.75–0.96; p = 0.01) and a higher risk of no response (RR 2.40; 95% CI 1.40–4.13; p = 0.002). No significant differences were seen for partial response (RR 1.24; 95% CI 0.94–1.64; p = 0.13; I2 = 0%), recurrence (RR 2.20; 95% CI 0.73–6.58; p = 0.16), or pain (RR 0.92; 95% CI 0.74–1.14; p = 0.46). Vitamin D3 was linked to more swelling (RR 2.79; 95% CI 1.15–6.75; p = 0.02), while MMR was associated with more erythema (RR 0.60; 95% CI 0.42–0.86; p = 0.006).
Conclusions
Intralesional MMR appears to be more effective than vitamin D3 for cutaneous warts, with superior clearance and distinct adverse event profiles. Larger, standardized trials are warranted to validate these effect sizes and optimize treatment strategies.
背景：皮肤疣是由人乳头瘤病毒引起的常见良性病变，通常对常规治疗无效。用麻疹-腮腺炎-风疹（MMR）疫苗或维生素D3进行局灶内免疫治疗已成为一种替代方法，但其相对疗效和安全性尚不清楚。方法：我们对包括742例患者在内的9项随机对照试验（rct）进行了系统回顾和荟萃分析，比较了病变内MMR与维生素D3治疗非生殖器皮肤疣的疗效。我们检索PubMed、Cochrane CENTRAL和ScienceDirect至2025年6月，该方案在PROSPERO （ID: 1128443）中注册。主要结局有完全、部分和无反应；次要结局是复发和不良事件（红斑、疼痛、肿胀）。计算合并风险比（rr）和95%置信区间（ci）。结果：维生素D3的完全清除率低于MMR (RR 0.85; 95% CI 0.75-0.96; p = 0.01)，无反应的风险更高（RR 2.40; 95% CI 1.40-4.13; p = 0.002）。在部分缓解（RR 1.24; 95% CI 0.94-1.64; p = 0.13; I2 = 0%）、复发（RR 2.20; 95% CI 0.73-6.58; p = 0.16）或疼痛（RR 0.92; 95% CI 0.74-1.14; p = 0.46）方面无显著差异。维生素D3与更多的肿胀相关（RR 2.79; 95% CI 1.15-6.75; p = 0.02），而MMR与更多的红斑相关（RR 0.60; 95% CI 0.42-0.86; p = 0.006）。结论：病变内MMR似乎比维生素D3对皮肤疣更有效，具有更好的清除率和明显的不良事件概况。需要更大规模的标准化试验来验证这些效应大小并优化治疗策略。
{"title":"Comparative Efficacy and Safety of Intralesional MMR Vaccine and Vitamin D3 in Managing Nongenital Warts: A Systematic Review and Meta-Analysis","authors":"Rahul Balach, Ayan Khalid, Anas Rasool, Aamna Kashif, Abdullah Ahmad, Aroosa Zafar, Muhammad Ibrahim, Aamir Shahid Javed, Misha Hasan, Somaiya Ahmed","doi":"10.1111/jocd.70618","DOIUrl":"10.1111/jocd.70618","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cutaneous warts are common benign lesions caused by human papillomavirus and often resist conventional treatments. Intralesional immunotherapy with measles–mumps–rubella (MMR) vaccine or vitamin D3 has emerged as an alternative, but their comparative efficacy and safety remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and meta-analysis of nine randomized controlled trials (RCTs) including 742 patients comparing intralesional MMR with vitamin D3 for nongenital cutaneous warts. We searched PubMed, Cochrane CENTRAL, and ScienceDirect up to June 2025, and the protocol was registered in PROSPERO (ID: 1128443). Primary outcomes were complete, partial, and no response; secondary outcomes were recurrence and adverse events (erythema, pain, swelling). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Vitamin D3 achieved lower complete clearance than MMR (RR 0.85; 95% CI 0.75–0.96; <i>p</i> = 0.01) and a higher risk of no response (RR 2.40; 95% CI 1.40–4.13; <i>p</i> = 0.002). No significant differences were seen for partial response (RR 1.24; 95% CI 0.94–1.64; <i>p</i> = 0.13; <i>I</i><sup>2</sup> = 0%), recurrence (RR 2.20; 95% CI 0.73–6.58; <i>p</i> = 0.16), or pain (RR 0.92; 95% CI 0.74–1.14; <i>p</i> = 0.46). Vitamin D3 was linked to more swelling (RR 2.79; 95% CI 1.15–6.75; <i>p</i> = 0.02), while MMR was associated with more erythema (RR 0.60; 95% CI 0.42–0.86; <i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intralesional MMR appears to be more effective than vitamin D3 for cutaneous warts, with superior clearance and distinct adverse event profiles. Larger, standardized trials are warranted to validate these effect sizes and optimize treatment strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15546,"journal":{"name":"Journal of Cosmetic Dermatology","volume":"25 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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